Hoarseness Research Articles

Pathological voice classification using MEEL features and SVM-TabNet model

In clinical settings, early diagnosis and objective assessment depend on the detection of voice pathology. To classify anomalous voices, this work uses an approach that combines the SVM-TabNet fusion model with MEEL (Mel-Frequency Energy Line) features. Further, the dataset consists of 1037 speech files, including recordings from people with laryngocele and Vox senilis as well as from healthy persons. Additionally, the main goal is to create an efficient classification model that can differentiate between normal and abnormal voice patterns. Modern techniques frequently lack the accuracy required for a precise diagnosis, which highlights the need for novel strategies. The suggested approach uses an SVM-TabNet fusion model for classification after feature extraction using MEEL characteristics. MEEL features provide extensive information for categorization by capturing complex patterns in audio transmissions. Moreover, by combining the advantages of SVM and TabNet models, classification performance is improved. Moreover, testing the model on test data yields remarkable results: 99.7 % accuracy, 0.992 F1 score, 0.996 precision, and 0.995 recall. Additional testing on additional datasets reliably validates outstanding performance, with 99.4 % accuracy, 0.99 F1 score, 0.998 precision, and 0.989 % recall. Furthermore, using the Saarbruecken Voice Database (SVD), the suggested methodology achieves an impressive accuracy of 99.97 %, demonstrating its durability and generalizability across many datasets. Overall, this work shows how the SVM-TabNet fusion model with MEEL characteristics may be used to accurately and consistently classify diseased voices, providing encouraging opportunities for clinical diagnosis and therapy tracking.

An unusual case of hoarseness of voice after left supraclavicular brachial plexus block

Supraclavicular brachial plexus block (SBPB) is a commonly used regional anesthetic technique for upper limb surgeries in orthopaedic patients. It provides intraoperative anesthesia and postoperative analgesia. SBPB can be administered using either a landmark approach or ultrasound guidance (USG). The use of ultrasound has reduced the complications associated with the block by providing excellent real-time visualization of the pleura, vessels, and plexus in relation to needle insertion. However, complications can still arise even with USG-guided block if a large volume of local anesthetics is used. In fact, a large volume is not necessary when performing USG-guided blocks.We report a case of a 25-year-old male who presented with hoarseness of voice after receiving a USG-guided supraclavicular block (left side) due to recurrent laryngeal nerve (RLN) block. While RLN block is more common in interscalene blocks, it is a rare complication in SBPB, with very few reported cases of hoarseness of voice due to RLN block after SBPB.

Effect of fluticasone-impregnated throat packs on postoperative sore throat (POST) and hoarseness of voice: A randomized clinical trial

Background Post-operative sore throat (POST) is one of the most common complaints post-endotracheal intubation and can be decreased through various interventions. This study aimed to determine the effect of fluticasone-impregnated versus saline throat packs on the occurrence and severity of POST and voice hoarseness. Methods This prospective, randomized, double-blinded trial was conducted on patients undergoing nasosinus surgeries at Kasturba Medical College and Hospital. Patients were randomized to groups based on a computer-generated table of random numbers post-intubation after placing a definite length of oropharyngeal packs into group F (fluticasone) who received four puffs of fluticasone furoate-soaked throat packs and group C (control) wherein normal saline-soaked throat packs were used. Determining the incidence of POST and voice hoarseness was the primary outcome; severity of POST and voice hoarseness, patient satisfaction scores at 24 hours post-surgery and adverse events were secondary outcomes. Results Overall, 86 patients were randomized and 43 patients were included in each group. Incidence of POST (%) and voice hoarseness (%) were 55.8, 55.6, 55.8, 53.4 and 30.2, 28, 28, 28 in group C. Incidence of POST (%) and voice hoarseness (%) were 37.2, 37.2, 37.2, 34.8 and 14, 14, 14,14 in group F at 1, 2, 6 and 24 hours, respectively, however, the p values were not found to be significant at any time interval. There was no significant difference in terms of severity of POST and voice hoarseness, patient satisfaction scores between the groups and there were no reported adverse events. Conclusions In patients undergoing nasosinus surgery under general anesthesia with endotracheal intubation, fluticasone furoate-impregnated throat packs failed to show any significant reduction in the incidence and severity of POST as well as hoarseness of voice, and even though it was not statistically significant, the fluticasone impregnated group had higher patient satisfaction scores. Registration CTRI (CTRI/2020/09/027946; 22/09/2020).

June 2024 Medical Image of the Month: A 76-year-old Man Presenting with Acute Hoarseness

No abstract available. Article truncated after 150 words. A 76-year-old man with a past medical history significant for coronary artery disease, diabetes mellitus, and 40-pack-year smoking history presented to the emergency department with 1 week of progressive hoarseness. Associated symptoms included a cough initially productive of green sputum that progressed to scant hemoptysis, as well as intermittent hiccups. Four days prior to presentation he sought treatment at a clinic in Mexico, where he was diagnosed with influenza and treated with Tamiflu and Moxifloxacin. His symptoms did not improve, prompting him to seek care at our hospital. On interview, he denied fevers, chills, dysphagia, otalgia, odynophagia, dyspepsia, chest pain, dyspnea, or weight changes. His temperature was 36.3°C, heart rate 75 beats per minute, blood pressure 150/77 mmHg, respiratory rate 22 breaths per minute, and oxygen saturation 93% on room air. On physical examination, the patient was found to have a hoarse voice, with an otherwise normal oropharyngeal exam. Cardiopulmonary …

The Representation of Gender Subalterns in Selected Khalid Hosseini’s Novels

The rights of women in Afghanistan have evolved throughout the years. Currently, the Taliban rule has taken the centre stage and once again women are the most affected gender. But this subjugation was not solely the doing of the Taliban’s rather it was how men treated women and men in Afghanistan. The staunch patriarchal society teaches Afghanistan women from young to live up to men’s expectations of a perfect women and in doing so women accept the myth that men are superior and become submissive to violence thereby causing their own downfall. Hosseini’s novel ‘A Thousand Splendid Suns’, highlights the plight and violence towards women ranging from the mother to daughter to granddaughter. The research aims to explore the depiction of the loss of voice of Afghan women and men and how they have fought back their suppressors during the Taliban regime using Gayathri Spivak’s “The Subaltern Theory”. The research will be conducted thematic analysis to explore Gender Subalternity among Afghanistan women and men. The research is hoped to significantly reveal the state and plight of women and men in Afghanistan from a man’s perspective.

A lecturer’s voice quality and its effect on memory, listening effort, and perception in a VR environment

Many lecturers develop voice problems, such as hoarseness. Nevertheless, research on how voice quality influences listeners’ perception, comprehension, and retention of spoken language is limited to a small number of audio-only experiments. We aimed to address this gap by using audio-visual virtual reality (VR) to investigate the impact of a lecturer’s hoarseness on university students’ heard text recall, listening effort, and listening impression. Fifty participants were immersed in a virtual seminar room, where they engaged in a Dual-Task Paradigm. They listened to narratives presented by a virtual female professor, who spoke in either a typical or hoarse voice. Simultaneously, participants performed a secondary task. Results revealed significantly prolonged secondary-task response times with the hoarse voice compared to the typical voice, indicating increased listening effort. Subjectively, participants rated the hoarse voice as more annoying, effortful to listen to, and impeding for their cognitive performance. No effect of voice quality was found on heard text recall, suggesting that, while hoarseness may compromise certain aspects of spoken language processing, this might not necessarily result in reduced information retention. In summary, our findings underscore the importance of promoting vocal health among lecturers, which may contribute to enhanced listening conditions in learning spaces.

Neurorehabilitation with vagus nerve stimulation: a systematic review.

To systematically review vagus nerve stimulation (VNS) studies to present data on the safety and efficacy on motor recovery following stroke, traumatic brain injury (TBI), and spinal cord injury (SCI). Data sources: PubMed, EMBASE, SCOPUS, and Cochrane. Clinical trials of VNS in animal models and humans with TBI and SCI were included to evaluate the effects of pairing VNS with rehabilitation therapy on motor recovery. Two reviewers independently assessed articles according to the evaluation criteria and extracted relevant data electronically. Twenty-nine studies were included; 11 were animal models of stroke, TBI, and SCI, and eight involved humans with stroke. While there was heterogeneity in methods of delivering VNS with respect to rehabilitation therapy in animal studies and human non-invasive studies, a similar methodology was used in all human-invasive VNS studies. In animal studies, pairing VNS with rehabilitation therapy consistently improved motor outcomes compared to controls. Except for one study, all human invasive and non-invasive studies with controls demonstrated a trend toward improvement in motor outcomes compared to sham controls post-intervention. However, compared to non-invasive, invasive VNS, studies reported severe adverse events such as vocal cord palsy, dysphagia, surgical site infection, and hoarseness of voice, which were found to be related to surgery. Our review suggests that VNS (non-invasive or invasive) paired with rehabilitation can improve motor outcomes after stroke in humans. Hence, VNS human studies are needed in people with TBI and SCI. There are risks related to device implantation to deliver invasive VNS compared to non-invasive VNS. Future human comparison studies are required to study and quantify the efficacy vs. risks of paired VNS delivered via different methods with rehabilitation, which would allow patients to make an informed decision. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=330653.

Impact of Dysphonic Schoolteachers' Voices on Children's Reaction Times according to Phonemic Contrasts.

This paper aimed at observing the impact of dysphonic voice on children's reception of a linguistic message by evaluating their reaction times (RTs) to instructions given by functional dysphonic and control female schoolteachers (STs). French minimal pairs such as /muʃ/ ("mouche" fly) versus /buʃ/ ("bouche" mouth) embedded in a carrier sentence "click on the drawing of…" were produced by two groups of 10 dysphonic and control female ST, matched in age and year of experience. The phonemical contrasts observed are voicing, nasality, consonantal place of articulation, vowel roundedness, and vowel place of articulation. The experimentation was presented in the form of a computer game to children from 7 to 10 years old. Two images illustrating the target words were presented, accompanied by the oral instructions recorded by ST. With a two-button box created for the experiment, children had to click as quickly as possible on the image corresponding to the instruction. Our results show that the RTs of all children are affected by the ST's dysphonia, regardless of their age and that they have significantly longer RT when discriminating minimal pairs contrasting in voicing when the instruction is given by a dysphonic speaker compared to the same instruction given by a control speaker. These observations could be explained by the fact that functional dysphonia is associated with improper use of the vocal folds and thus an alteration of voicing.

A large, locally aggressive giant cell tumour arising from the laryngeal cartilage: A Rare Case Report

Giant cell tumour is a growth predominantly found in long bones of the body. Giant cell tumour has a rare occurrence in the head and neck. A case of a 31 year old male with no known comorbidities at the ENT Department, Shifa International Hospital, Islamabad presented with anterior neck swelling and hoarseness of voice. Patient was diagnosed as having Giant Cell Tumour of Larynx (GTCL) proven on FNA cytology and post-operative biopsy. GCTL is an uncommon entity with only 45 reported cases in the world. Key Words: Giant Cell Tumor, Laryngeal Cancer, Thyroid Cartilage, Laryngectomy.

The extraordinary case of a welder: retrieval of foreign bodies via transcervical neck exploration

Penetrating foreign bodies in the neck can be challenging to locate, especially given the complex anatomy of neck and edematous tissue planes following injury. These foreign entities require prompt surgical exploration for their removal because of risk of migration. Retrieval of foreign bodies relies upon their size and surrounding anatomical tissues. We are reporting an uncommon instance in which an iron chip accidentally penetrated patient's neck, producing acute hoarseness of voice and agony. The foreign body was removed via transcervical neck exploration.

CO2 laser in benign vocal fold lesions: an observational study

BackgroundTo evaluate the clinical and functional outcome of patients having benign vocal fold lesions who were treated with carbon dioxide laser.MethodsFor this Study a total of 41 Patients who had hoarseness of voice and satisfied the inclusion criteria were included. A detailed medical history and a thorough ENT examination was performed. Voice evaluation was done using (G)rade, (R)oughness, (B)reathiness, (A)sthenia….weakness (S)train (GRBAS), voice handicap index (VHI), and maximum phonation time scores.ResultsAll 41 patients reported hoarseness of voice as their primary complaint, and most of them developed their symptoms gradually. The following causes seem to have contributed to the presence of hoarseness of voice: LPR in 8 patients, smoking in 25 patients, voice abuse in 14 patients, and irritation exposure in 6 patients. The most frequent lesion in 25 (60.97 percent) of the subjects was a vocal polyp. This study showed majority of patients 35 (85.4%) had posterior phonatory gap and six (14.6%) had anterior gap preoperatively. All patients had incomplete glottic closure preoperatively, whereas glottic closure was complete at first follow-up postoperatively. The mean preoperative GRBAS score in study subjects was 10.972 with an SD (standard deviation) of 2.1724 and a median of 10.000. The mean postoperative GRBAS score at six months was 0.268 with an SD of 0.4486, median 0.000, Z score − 5.618, and p value < 0.001 which is statistically significant.ConclusionPrecision, hemostasis, and minimal postoperative edema are benefits of using carbon dioxide laser. This research therefore supports the idea that benign vocal fold lesions might be successfully treated with the super-pulsed microspot carbon dioxide laser, which offers good voice outcomes.

A Vocal Cord Polyp: An Atypical Case of Molluscum Contagiosum.

A 44-year-old patient presented with hoarseness of voice and a polypoidal lesion on the left vocal cord. Complete excision was done. To our knowledge, this is the second reported case of molluscum contagiosum of the vocal cords. It should be considered as a differential diagnosis of a vocal cord lesion.

Effect of medical mask on voice in patients with dysphonia

AbstractObjectiveMedical masks have been shown to significantly influence speech communication in healthy people. The effect of mask‐wearing on phonatory capability and daily communication exchanges in patients with voice disorders remains unclear. To evaluate the effect of the medical mask on acoustic parameters in patients with a voice disorder, we measured the voice frequency, quality, and intensity.MethodsThirty‐three healthy and 44 voice disorder patients were involved in this study, including 27 patients with vocal‐fold lesions and 17 with primary functional dysphonia. Perceptual evaluation and acoustic parameters, including F0 (fundamental frequency), jitter, shimmer, and maximum vocal intensity, were analyzed without and with medical masks.ResultsWith medical mask‐wearing, the maximum vocal intensity significantly decreased in all patients with voice disorders (p &lt; 0.05), especially in patients with lesions of vocal folds (p &lt; 0.05) and functional dysphonia (p &lt; 0.05). The perceptual evaluation roughness scales also increased in patients with lesions of vocal folds (p &lt; 0.05) and functional dysphonia (p &lt; 0.05) with mask‐wearing. There were no significant effects of mask‐wearing on acoustic parameters for healthy participants.ConclusionsThe intensity was influenced when wearing medical masks in patients with disordered voices. The voice perceptual roughness scales also significantly increased compared to those without medical masks.

Supraglottitis: An airway emergency

Supraglottitis is a life-threatening condition and refers to inflammation of the epiglottis and the surrounding supraglottic structures. Children usually present with only a swollen epiglottis, termed epiglottitis. Fortunately, the incidence of epiglottitis in children has declined following routine Haemophilus influenzae type B vaccination, but the incidence in adults has increased. Supraglottitis has a high morbidity and mortality from the associated risk of airway obstruction. Therefore, early recognition and urgent secondary care referral is paramount. However, the presentation of this condition can be subtle and differs between children and adults; this can lead to difficulties in diagnosis. This article will review the clinical presentation and management of supraglottitis, an important differential for acute sore throat and hoarse voice.

Sertoli-Leydig Cell Tumour in a Patient with Ambiguous Genitalia and Congenital Adrenal Hyperplasia

Background: Hyperandrogenism, characterized by elevated levels of male hormones such as testosterone, presents various clinical manifestations including secondary amenorrhea, hirsutism, and clitoromegaly. While often associated with polycystic ovarian syndrome, other differentials such as Sertoli-Leydig cell tumors and Congenital Adrenal Hyperplasia (CAH) are critical to consider. These conditions can manifest at different life stages and are seldom seen together. Objective: This case study aims to explore the rare co-presentation of CAH and a Sertoli-Leydig cell tumor in a patient presenting with secondary amenorrhea and ambiguous genitalia, and to discuss the diagnostic challenges and management strategies involved. Methods: A 16-year-old female presented with irregular menstrual cycles and secondary amenorrhea, alongside symptoms of hyperandrogenism such as voice deepening and hirsutism. Diagnostic procedures included physical examinations, ultrasound imaging, and hormone level assessments. A detailed ultrasound revealed a large right-sided ovarian mass, and biopsies confirmed a Sertoli-Leydig cell tumor. Surgical intervention involved the excision of the mass, with subsequent histopathological examination. The patient underwent three cycles of chemotherapy and was scheduled for reconstructive surgery. Results: Ultrasound dimensions of the ovarian mass were 7.2 x 13.4 x 16 cm, with the post-surgical tumor measuring 18 x 17 cm. Laboratory findings included testosterone levels above 200 ng/ml, and elevated alpha-fetoprotein levels. The histopathological report confirmed a poorly differentiated Sertoli-Leydig cell tumor (FIGO stage 1a). Post-treatment follow-up showed a marked reduction in androgen levels and stabilization of the patient's menstrual cycle. Conclusion: The coexistence of CAH and a Sertoli-Leydig cell tumor presents unique diagnostic and therapeutic challenges. This case emphasizes the importance of a thorough evaluation and a multidisciplinary approach in the management of complex hyperandrogenic states to achieve optimal clinical outcomes.

Cutaneous manifestations of hypothyroidism: An observational study in a tertiary care center of Eastern India

Cutaneous manifestations of hypothyroidism: An observational study in a tertiary care center of Eastern India

Comparison of Endotracheal Tube Cuff Pressure change between Supine prone and Supine – Knee Chest Position in Lumbar Disc Surgery

Background: In rare instances, massive over inflation of the cuff may lead to acute complications such as tracheal bleeding or rupture. This may be associated with post-operative complications like sore throat hoarseness of voice. The purpose of this study was to evaluate the ETT cuff pressure changes between supine to prone and supine to knee chest position in lumber disc surgery. Materials &amp; Methods: Sixty patients, aged between 18 to 60 years of either sex, belonging to American Society of Anaesthesiology (ASA) physical status I to II undergoing elective lumbar disc surgery under general anaesthesia either in prone position or in knee-chest position were considered for this study. The patients were randomly allocated into two groups of 30 patients each. Group “p” was undergone operation in prone position and group “k” undergone operation in knee-chest position. The patients were connected to standard monitoring system such as non-invasive blood pressure (NIBP), electrocardiogram (ECG), pulse oxymeter, and capnometer. All patients were pre-medicated with inj. glycopyrrolate 0.2 mg and inj. fentanyl 2µg/kg iv 5-6 minutes before induction of anaesthesia and were pre-oxygenated with 100% oxygen for atleast 3 minutes. All the patients were induced with inj. propofol 2.5 mg/kg i.v. followed by inj. rocuronium at a dose of 1.2 mg/kg for facilitating tracheal intubation with reinforced ETT. The ETT size selected for men and women were 8.0-8.5 mm ID and 7.0- 7.5 mm ID (Mallinckrodt) respectively. Results: Group k patients showed higher cuff pressure change from 25 to 39.97cm of H2O compared to group p from 25 to 30.47 cm of H2O after change of position only. There was statistically significant different found between groups Sore throat was found significantly higher in group k compared to group p (20% vs 16.67%). Conclusion: The cuff pressure of the endotracheal tube should be monitored and managed properly after the position change from supine to prone and prone to knee chest position.

A vocal cord palsy caused by the uterine cancer metastatic tumor in the mediastinum revealed in a patient with a thyroid lesion: a case report and review of the literature

BackgroundThe main cause of vocal cord palsy (VCP) is idiopathic impairment of the recurrent laryngeal nerve (RLN). However, solid tumors along the pathway of the RLN can also impact the nerve’s function. We presented a patient with a thyroid lesion and VCP due to a bulky metastatic mass (uterine cancer) on the aortic arch field in the mediastinum. The report aims to show the significance of comorbid tumors in thyroid pathology and the importance of additional diagnostic methods in avoiding unnecessary surgeries. A patient’s lifetime and the outcome of the disease were also presented.Case presentationA 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.ConclusionA history of the disease should always be kept in mind when assessing a patient’s complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.

Do Effects of Voice Rehabilitation in Patients Irradiated for Laryngeal Cancer Remain 5 Years Postradiotherapy?

Laryngeal cancer treated by radiotherapy results in many patients being left with an abnormal voice long-term. This prospective study aims to report efficacy of voice rehabilitation 5years postradiotherapy completion. Seventy-seven patients were randomized into an intervention group (n=37) or a control group (n=40). Voice rehabilitation was administered postradiotherapy. Patients were followed at baseline, 12- and 60-month postradiotherapy with voice recordings assessed using GRBAS protocol (Grade, Roughness, Breathiness, Asthenia, Strain). Patients filled in the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Head and Neck 35 (EORTC QLQ-HN35) and the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer (S-SECEL). There were no statistically significant differences between the intervention and control group in scores reported on EORTC QLQ-HN35, S-SECEL or in perceptual evaluation at study end-point. The intervention group reported an improvement in EORTC QLQ-HN35 Speech between baseline-60months postradiotherapy. No significant changes between 12-60months were observed. The control group demonstrated significant improvement in domains Pain, Senses, Speech, Social eating and Sexuality from baseline-60months postradiotherapy, of which only Speech showed a statistically significant change between 12-60months postradiotherapy (P=0.02). Both groups reported improved S-SECEL scores from baseline-60months, with no significant dynamic between the 12- and 60-month follow-up. Previously observed positive effects of voice rehabilitation on patient communicative skills and perceptual evaluation are no longer noticeable at 5-year post voice therapy completion. Nevertheless, patients receiving voice rehabilitation experience a greater improvement within the first year, which in the control group takes a corresponding 5years.

An Unusual Presentation of Squamous Cell Carcinoma in a Never Smoker: A Case Report

Lung Cancer is one of the most common types of cancer found among smokers. However, approximately 10% of lung cancer patients are non-smokers. Non-smokers are frequently seen developing Adenocarcinoma, a type of non-small cell carcinoma with a female predominance. The incidence of Squamous cell carcinoma among non-smokers is very low. Moreover, studies have shown that tetra site metastasis in the case of Squamous cell carcinoma of the lung is almost as rare as 0.6% [1]. The authors report here in this article a case report of a rare and aggressive presentation of Squamous cell carcinoma in a non-smoker. This is a case of a 50-year-old male patient who is a non-smoker, presented with complaints of exertional dyspnoea and cough with expectoration for 3 months which had aggravated since 15 days, associated with hoarseness of voice and diffuse headache since 15 days. There was a history of significant weight loss and loss of appetite for 3 months. CECT thorax revealed a heterogeneously enhancing mass lesion in the anterior segment of the left upper lobe encasing the left pulmonary artery with evidence of liver, adrenal and vertebral metastasis. During the hospital stay, the patient developed complete ptosis of the right eye. MRI brain was done which showed features suggestive of metastasis involving bilateral cerebral and cerebellar hemispheres. USG guided lung biopsy was done and was suggestive of moderately differentiated Squamous cell carcinoma. The patient was planned to be further worked up for IHC markers and PET CT scan to determine the further line of treatment however, unfortunately, the patient succumbed to the disease within 1 week of histopathological diagnosis.